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04-APRIL-2008  ASMAA HUSSEIN AL-LOH  30 YEARS  POSTTRAUMATIC FRACTURE DISLOCATION C3-4 WITH RIGHT LOCKED FACET AND MALACIA OF THE SPINAL CORD AT LOWER LEVELS.

Anamnesis:

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The patient came to Al-Shmaisani hospital after suffering RTA 22-March-2008 with loss of consciousness for several hours. She was complaining of right upper limb pain and both shoulders pain and there was fracture of the forearm, for what an above elbow cast was applied to the right upper limb.

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MRI of the cervical spine and brain CT-scan was performed, which confirmed the presence of dislocation of C3-4 and locked right C3-4 facet and malacia of the spinal cord below this level in the cervical spinal cord. X-ray of the cervical spine in flexion and extension showed that there also instability at this area.

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On examination: the patient had weak right deltoid and biceps brachii muscle. There was also weak planterflexion of the right foot and dorsiflexion both feet and weak right quadriceps without LBP.

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Using image-intensifier, the level was identified and discectomy of C3-4 was performed with traction applied using Hallo traction device with 5 KG weight. The traction was increase to 8 KG and it was possible to see that the entire posterior longitudinal ligament was torn completely. The dura was intact and no CSF leak could be noted. Using Hybrid one level miniplate with four 14 mm length screws, fusion of C3-4 was performed with the aid of image-intensifier.

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Routine closure of the wound with smooth postoperative recovery.

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Immediate improvement of the power of the affected limbs.

Comments

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The malacia of the spinal cord at lower levels was due to massive dislocation during accident.

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The improvement of the power of the four limbs could be to the still persisting dislocation of C3-4, which was corrected with subsequent improvement.

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